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Global Emerging Fungal Infection Registry

Initiated in 2003

Report September 2012

Working group of the

Under the auspices of

Supported by unrestricted grants from Astellas Pharma, Gilead Sciences, Merck and Pfizer

Report September 2012 Page 2 of 34

Study Coordinators ........................................................................... 3

Introduction .................................................................................... 6

Current Results ............................................................................... 10

Achievements and Goals .................................................................. 17

Presentations 2012, 2011, 2010 ..................................................... 17

Publications ................................................................................. 18

Awards ........................................................................................ 18

Recent Accomplishments ............................................................... 18

2012 Goals .................................................................................. 19

Contact Information ......................................................................... 20

Participating Institutions................................................................... 21

Report September 2012 Page 3 of 34

Clinical ID Microbiology Molecular Biology Pharmacology Pathology

Austria

Elisabeth Presterl, MD Allgemeines Krankenhaus -Universittskliniken Wien Whringer Grtel 18-20 1090 Wien T +43-1-40400-4440 F +43-1-4400-4418 elisabeth.presterl@meduni wien.ac.at

Cornelia Lass-Flrl, MD Institute of Hygiene, Microbiology and Social Medicine Universitt Innsbruck Fritz-Pregl-Str. 3 6020 Innsbruck T +43-512-9003-70725 F +43-512-9003-73700 cornelia.lass-floerl@uibk.ac.at

Walter Buzina, MD Institut fr Hygiene Medizinische Universitt Universittsplatz 4 8010 Graz T +43-316-380-7719 F +43-316-380-9648 walter.buzina@meduni-graz.at

Ulrich Strasser. MD Institut fr Pathologie Medizinische Universitt Innsbruck Mllerstr. 44 A-6020 Innsbruck T +43-512-9003-71304 F +43-512-582-088 ulrich.strasser@i-med.ac.at

Brazil

Marcio Nucci, MD Hospital Universitrio Universidade Federal do Rio de Janeiro Av. Brigadeiro Trompovsky S/N 21941-590 Rio de Janeiro T +55-21-2562-2463 F +55-21-2562-2460 mnucci@hucff.ufrj.br

Czech Republic

Zdenk Ril, MD Dept. of Internal Medicine University Hospital Brno Jihlavska 20, 62500 Brno T +420-53223-2830/3642 F +420-53223-3603 zracil@fnbrno.cz

Iva Kocmanova, MD Dept. of Microbiology University Hospital Brno, Jihlavska 20, 62500 Brno T +420 53223 2974 ikocmanova@fnbrno.cz

Martina Lengerova, MD Dept. of Internal Medicine Hemato-Oncology University Hospital Brno Jihlavska 20, 62500 Brno T +420 53223 3642 mlengerova@nbrno.cz

Mojmir Moulis, MD Dept. of Pathology University Hospital Brno Jihlavska 20, 62500 Brno T +420 53223 1111 mmoulis@fnbrno.cz

Ludmila Malaskova, MD Dept. of Biochemistery University Hospital Brno Jihlavska 20, 62500 Brno T. +420 53223 3073 lmalas@fnbrno.cz

mailto:elisabeth.presterl@meduniwien.ac.atmailto:elisabeth.presterl@meduniwien.ac.atmailto:cornelia.lass-floerl@uibk.ac.atmailto:walter.buzina@meduni-graz.atmailto:ulrich.strasser@i-med.ac.atmailto:mnucci@hucff.ufrj.brmailto:zracil@fnbrno.czmailto:ikocmanova@fnbrno.czmailto:mlengerova@nbrno.czmailto:mmoulis@fnbrno.czmailto:lmalas@fnbrno.cz

Report September 2012 Page 4 of 34

Clinical ID Microbiology Molecular Biology Pharmacology Pathology

Germany

Oliver A. Cornely, MD, FIDSA, FACP Klinikum der Universitt Klinik I fr Innere Medizin 50924 Kln T +49-221-478-6494 F +49-221-478-3611 oliver.cornely@ctuc.de

Guido Fischer, MS, PhD Landesgesundheitsamt Baden-Wrttemberg Referat 96 - Arbeitsmedizin, umweltbezogener Gesundheitsschutz Nordbahnhofstrae 135 70191 Stuttgart T +49-711-904-39620 F +49-711-904-37105 guido.fischer@rps.bwl.de

Ralf Bialek, MD MVZ Labor Dr. Krause Steenbeker Weg 25 24106 Kiel T +49-431-388-252 bialek@labor-krause.de

Carsten Mller, MD Klinikum der Universitt Institut fr Pharmakologie 50924 Kln T +49-221-478-5066 F +49 221 478 7184 c.mueller@uni-koeln.de

Axel Hamprecht, MD Klinikum der Universitt Institut f. Mikrobiologie, Immunologie u. Hygiene Goldenfelsstr. 19-2 D-50935 Kln T +49-221-478 32023 F +49-(0)221-478-32134 axel.hamprecht@uk-koeln.de

India

Anupma Jyoti Kindo, MD Dept. of Microbiology Sri Ramachandra Medical College/Research Institute No.1, Ramachandra Nagar Porur, Chennai, 600 116 T +91-944-523-9196 F +91 44 2476 5608 anupmalakra@yahoo.com

mailto:oliver.cornely@ctuc.demailto:guido.fischer@rps.bwl.demailto:bialek@labor-krause.demailto:c.mueller@uni-koeln.demailto:anupmalakra@yahoo.com

Report September 2012 Page 5 of 34

Study Coordinators

Clinical ID Microbiology Molecular Biology Pharmacology Pathology

Israel

Morad Wattad, MD Rabin Medical Center Infectious Diseases Unit 39 Jabotinski St. 49100 Petah Tikva T +972-3-937-7377 F +972-3-937-6365 Moradv@clalit.org.il

Italy

Livio Pagano, MD Dipartimento di Ematologia Universita Cattolica del Sacro Cuore (Roma) Largo Francesco Vito 1 00168 Roma T +39-6-355-03953 F +39-630-51343 lpagano@rm.unicatt.it

Maurizio Sanguinetti, MD Istituto di Microbiologia (Roma) Universit Cattolica del Sacro Cuore Largo Francesco Vito 1 00168 Roma T +39-06-3015-4964 F +39-06-3051-152 msanguinetti@rm.unicatt.it

Annamaria Tortorano, MD Dip. Sanit Pubblica-Microbiologia-Virologia Milano Universit di Milano Via Pascal, 36/38 20133 Milano T +39-2-503-15145 F +39-2-503-15146 annamaria.tortorano@unimi.it

Andrea Novelli, MD Dipartimento di Farmacologia Universit degli Studi di Firenze Viale Pieraccini, 6 50139 Firenze T +39-055-4271-286 F +39-055-4271-280 andrea.novelli@unifi.it

Gianluigi Vago, MD Department of Clinical Sciences Luigi Sacco Hospital University of Milan Via Pascal, 36/38 20133 Milano T +39 0285994869 F +39 0285994800 Gianluca.vago@unimi.it

Turkey

Sevtap Arikan-Akdagli, MD Mycology Laboratory (Ankara) Hacettepe University 06100 Ankara F +90 (312) 3115250 sevtap.arikan@gmail.com

mailto:Moradv@clalit.org.ilmailto:lpagano@rm.unicatt.itmailto:msanguinetti@rm.unicatt.itmailto:annamaria.tortorano@unimi.itmailto:andrea.novelli@unifi.itmailto:Gianluca.vago@unimi.itmailto:sevtap.arikan@gmail.com

Report September 2012 Page 6 of 34

Introduction The incidence of invasive fungal infections (IFI) is increasing in all parts of the world. The etiology for this ongoing epidemiological development is not completely understood. However, major contributing factors are the increasing number of transplantation procedures undertaken around the world (estimated at 500,000 per year), a widening of the indications for intensive chemotherapy, and the growing number of other clinical conditions requiring immunosuppressive treatment.

Therapeutic standards have been developed for the most frequent IFI, i.e. candidiasis, aspergillosis and cryptococcosis. However, the so called emerging fungi are also a reason for the increased number of IFIs. Thus, clinicians are now facing infections due to a variety of different fungi without any reliable treatment recommendations and therapeutic decision making is not evidence based. Prevalence of emerging fungi is virtually unknown and there is an additional knowledge gap in pathogen biology, since isolates have not been collected systematically.

In order to overcome the lack of knowledge on epidemiology, clinical course, biology and pathomechanisms, and finally to develop an evidence based diagnostic-therapeutic integrated approach of IFI caused by emerging fungi, A Global Emerging Fungal Infection Registry Fungiscope has been created.

Fungiscope uses a web-based electronic case form accessible via www.fungiscope.net. For inclusion into the registry patients require cultural, histopathological, serological or molecular evidence of IFI and the associated clinical symptoms and signs. The clinical data on underlying disorder and IFI will be collected and stored in an internet-based database. Additionally, the pathogen strains and samples of infected tissue are collected, examined and stored in a bio-bank the Fungithek. The clinical and biological data are subsequently evaluated and analysed. Figure 1a and b present the data / sample flow and overall project structure. The clinical database and the bio-bank are connected and accessable to the public via a web-based search engine - FungiQuest (figure 2).

In the following report we introduce the most current results and achievements. We also discuss future goals and ongoing developments of the project.

Report September 2012 Page 7 of 34

Figure 1a: Project structure

Report September 2012 Page 8 of 34

Figure 1b: Material flow

Report September 2012 Page 9 of 34

Figure 2: FungiQuest database search engine

Report September 2012 Page 10 of 34

Current Results Until now, 299 cases have been documented and considered valid. The most frequently registered pathogens were Mucorales (previously termed Zygomycetes) (n=118; 39.5%), Fusarium spp. (n=51; 17.1%), yeasts (n=43; 14.4%), and Dematiaceae (n=34; 11.4%) followed by Penicillinum spp. / Paecilomyces spp. (n=15; 5.0%) and Scedosporium spp. (n=13; 4.3%) (figure 3). The majority of patients were Caucasian followed by Asian and North/South American Indian ori

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